Nipple areolar complex (NAC) or skin flap ischemia necrosis post nipple sparing mastectomy (NSM)-Analysis of clinicopathologic and breast magnetic resonance imaging (MRI) factors

Background: The purpose of this study is to identify clinicopathologic factors and/or pre-operative MRI vascular patterns in the prediction of ischemia necrosis of the nipple-areola complex (NAC) or skin flap post nipple sparing mastectomy (NSM). Methods Patients who received NSM were retrospectively retrieved from a prospectively collected breast cancer database in one institute. The ischemia necrosis of NAC or skin flap was evaluated with clinicopathologic factors and types of skin incision. Patients who received NSM with pre-operative MRI evaluation were further evaluated for the vascular pattern and the impact on ischemia necrosis of NAC or skin flap. Results A total of 441 cases received NSM enrolled in current study, and the mean age of them was 49.1 ± 9.8-year-old. A total of 41(9.3%) NSM procedures were graded as NAC ischemia necrosis. Risk factors associated with NAC necrosis were evaluated, and old age, large mastectomy specimen weight (> 450gm), and peri-areola incision were identified. 270 NSM procedures also received pre-operative MRI, and the blood supply pattern was 18% single vessel type, and 82% double vessel. There was no correlation of MRI blood supply pattern to ischemia necrosis of NAC, nor correlated with NAC ischemia necrosis in either type of skin flap incision. There was no correlation between blood loss and pattern or size of blood vessel. Conclusion Certain factors, like the type of skin incision, age, and size of mastectomy weight, played important role in ischemia necrosis of NAC, however, MRI vascular (single or dual vessel supply) pattern was not a significant predictive factor.